Lucy Puryear, M.D.
Lucy Puryear, M.D.

Lucy Puryear, M.D., destigmatizes psychiatric conditions during pregnancy and postpartum

The expert psychiatrist at Texas Children’s Pavilion for Women talks postpartum depression, juggling a career with motherhood and what resonates most with her patients

Lucy Puryear, M.D., destigmatizes psychiatric conditions during pregnancy and postpartum

11 Minute Read

Lucy Puryear, M.D., helps patients overcome postpartum depression, treats psychiatric conditions for women during pregnancy and addresses mental health conditions related to reproductive issues and pregnancy loss. She serves as the medical director of The Women’s Place: Center for Reproductive Psychiatry and the co-director of The Menopause Center at Texas Children’s Pavilion for Women. Puryear also holds the Maureen Hackett Endowed Chair for Reproductive Psychiatry at Texas Children’s Hospital and is an associate professor of Obstetrics and Gynecology in the Menninger Department of Psychiatry at Baylor College of Medicine. Because of her work and breadth of experience, she served as an expert witness in the trial and retrial of Andrea Yates, a Houston woman who was convicted and later acquitted by reason of insanity after confessing to drowning her five young children in 2001.

Q | You were born in Houston, grew up in Baltimore, then pursued a career in theater after college. How did you find your way to medicine?
A | My dad’s a psychiatrist and my mom’s a nurse, so I grew up in a medical family. I was born when they were quite young, and I have very early memories watching my dad study and sitting at his feet while he was looking through medical journals. That was always part of the culture in our house, and I always imagined I was going to grow up and become a doctor. I went to college and started out pre-med, but first semester freshman year I tried out for a play and actually ended up getting the lead. I got very involved in the theater department very quickly, which did not coordinate well with my 8 a.m. calculus class, and I ultimately changed to being a theater major. But I kept being interested in science and I remember being very conflicted about what I wanted to do, so I did keep taking some pre-med courses.

I graduated with a degree in theater and went to New York City for a year, but I quickly realized that it was going to be really hard to be successful there. I wanted to get back into the medical field, so I went to nursing school, and it was during nursing school when I realized, once again, that I actually really wanted to be a doctor. But I finished nursing school first; I’d already had a bachelor’s degree, so I only had to do two years of the clinical to get my bachelor’s in nursing. I started working in a neonatal intensive care unit, and while I was doing that, I went back and started taking all the pre-med classes that I hadn’t finished or still needed to take. That took me about four years, and at that time I had moved to Houston, so I was working at the NICU at Memorial Hermann, and then I got into Baylor for medical school. That was a great day—it was something I had wanted for such a long time and had thought maybe it was too late or I’d taken too long to get there, so it was a really proud moment.

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Q | You specialize in psychiatric conditions related to pregnancy and postpartum depression. Why is this field so important?  
A | I’ve always been interested in women’s health. My parents were pretty young when they got married, and I grew up during the Vietnam War era, and my parents were politically astute and we had lots of conversations around the dinner table about politics and justice and social reform. I also grew up during the women’s movement, and I think that, as a girl, I was really drawn to equal rights. When I thought about being in medicine, women’s health in general always interested me. In medical school, I thought for a while I was going to be an OB-GYN. I started in 1988 and graduated in 1992, and it was still a very male-dominated field at the time. I was more drawn to taking care of women in a more compassionate and more emotional kind of way, so that’s what I was going to go into. Then I did my psychiatry rotation at the end of medical school, and I really fell in love with just being able to talk to people and listen to people’s stories. I felt like people with mental illness were a very marginalized, stigmatized, underserved group of people. Not only did I find it interesting, but it also met my instincts for helping the underdog and standing up for justice and what’s right.

When I was training to be a psychiatrist, the choices for women who wanted to have children who had psychiatric illnesses were very limited. They were told they either had to stop their medicine—so that meant that if they had depression or bipolar disorder or schizophrenia, they were told if you wanted to have a baby, you have to stop your medicine completely—or they were told they just couldn’t have children. They’re already being stigmatized by having a psychiatric illness, and then they’re being doubly stigmatized by being told they can’t be mothers and also being told to just stop their medicine. Nobody is going to tell a pregnant woman with high blood pressure or diabetes or multiple sclerosis to stop her medicine while she’s pregnant. So, it was a real passion for being an advocate and a voice and an expert for helping women who might need to take medication during pregnancy. I didn’t think that just because you had a diagnosis of depression or bipolar disorder that meant you couldn’t be a good mother.

Q | Even today, there is still such a stigma surrounding mental health conditions, including those related to pregnancy. What do you find most troubling about the public perception of postpartum depression?
A | I think the Andrea Yates trial here in Houston really changed the landscape for the understanding and acknowledgment of postpartum psychiatric illnesses—that they’re real, that they’re serious and that women may struggle after having a baby. However, I think there still is a misunderstanding that postpartum depression means that you’re going to hurt your baby and that’s not true at all. Women who hurt their babies or hurt their children are actually suffering from postpartum psychosis, which is a much different illness and extraordinarily rare, and it’s not the same thing as postpartum depression. Anywhere between 10 and 20 percent of women have postpartum depression and these women do not harm their children.

Q | Last year, the U.S. Food and Drug Administration (FDA) approved, for the first time, a drug to help treat postpartum depression—brexanolone. It’s expensive but showed promise. What are your thoughts about it?
A | It’s exciting because I think it acknowledges that postpartum depression is a real illness that deserves research. It also supports the fact that it may be a different illness than just major depressive disorder, that there may be something unique about it that’s causing symptoms during the postpartum period. It’s also a hormonally-based treatment, so that supports our belief that postpartum depression and postpartum illnesses are related to hormonal changes. It works very quickly, which is super exciting, because it’s very frustrating to have a new mom who’s really struggling and our usual medication treatments can take three to four weeks to start working. Having something that can work in 24 to 48 hours is just extraordinarily exciting. That being said, it’s complicated, because it’s administered through an IV, so you have to have someone in a hospital-like setting. And, it’s expensive. Still, I think as a starting place it is a huge game-changer in the field.

Q | What do you recommend for women who are uninsured or underinsured but may need expert help for a pregnancy-related psychiatric illness?
A | Fortunately, in Texas, legislation was passed that allows women who had Medicaid during pregnancy to be automatically enrolled in Healthy Texas Women, which makes them eligible for postpartum care, including treatment for postpartum depression. We [Texas Children’s Pavilion for Women] were able to become providers for Healthy Texas Women, and there are a lot of medications that we use that are either covered by that plan or can be accessed for $4 a month, so we have ways of helping people find affordable medication. Therapy is more complicated, but there are online resources. Postpartum Support International is a great resource where you can find free online support and free group therapy.

Q | As a psychiatrist, what seems to resonate the most with your patients?
A | There is actually something I pretty much say to everyone, and it is, ‘You will get better.’ I do a lot of reassurance that this is a treatable illness, that it does get better, that it’s hard now, but you won’t feel this way forever and that we have treatments to help you get better. That’s one of the joys of what I do. Women come really struggling and having a hard time taking care of their babies, having a hard time taking care of themselves, and four to six weeks later when I see them again they’re smiling, they’re sleeping, they’re feeling more connected and more bonded. I also tell everyone it’s not their fault; it doesn’t mean that they’re a bad mother, it doesn’t mean that they don’t love their children or their baby. It’s a real illness like any other medical illness that you need help with and sometimes that means you need to take medication and sometimes you don’t.

Q | In 2008 you published a book, Understanding Your Moods When You’re Expecting: Emotions, Mental Health, and Happiness—Before, During, and After Pregnancy. What drew you to that endeavor?
A | I wanted a book that women could go to that had competent medical information in it but was also compassionate and easy to read. I talk about myself a lot in the book and I wanted to just normalize women’s experiences and give women a voice and really talk about the stuff about motherhood that women don’t talk about often—like how hard it is, and how sometimes you don’t feel like you like your kids and how sometimes you do things that are mistakes. It was a desire to really speak out loud the truth about being a mom, that while it’s often wonderful, day-to-day sometimes it’s not. One of the things I think I say in the book, and I say this to moms now, is that most days, I’m a good enough mom. Some days I’m a great mom—some days I just knock it out of the park—and then some days I’m really not any good. But most days I’m just pretty good, and more days than not I’m good enough, and that’s really all that’s required.

Q | You’re a mother of four children. Did you ever experience any mental health illnesses related to your pregnancies?
A | I did not, although I certainly could have. I was fortunate and did not, but it wasn’t because there’s something special about me. It’s just luck.

Q | What’s your best advice for juggling a career and parenting?
A | I had to learn this the hard way, but my best advice is to compartmentalize. I told myself that when I was at work, I was going to be 100 percent focused on work and not be worried about my kids—and the only way you can do that is if you are 100 percent comfortable with who’s watching your children. That being said, when you’re at home, you need to give 100 percent of yourself to your kids and your home life, and not try to juggle work and kids at the same time. Now, when my kids went to bed and were asleep, that’s when I would write my book or I could go back to work. But you really have to not shortchange either one.

Q | Final question: Do you have a mantra you live by?
A | One is: I can only do the best I can do. I think sometimes we all want to be better or be more perfect, particularly when things are chaotic or being thrown at us. The second piece is being kind to myself—and part of that is ‘I can only do what I can do.’ Sometimes that means I don’t finish or I don’t get to something or I don’t do something as well as I might like to, but I can only do the best I can do, and that’s a way of being kind to myself. And then the corollary of that is that I always try to assume the best of people—that people are trying to do the best they can do, too. That’s kind of how I try to live my life.

This interview has been edited for clarity and length.

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